Medical Insurance Accounts Receivable Specialist

Job Title:

Medical Insurance Accounts Receivable Specialist Department:

AR Location:

San Antonio, Texas (in office)

Reports To:

Supervisor, A/R FLSA Status:

Non-exempt Summary of Position:

The A/R Specialist is responsible for efficient, timely, accurate resolution of account receivables; properly processing all explanations of benefits (EOBs) and correspondence received based on payer; identifying incorrect payments, and communicating discrepancies to supervisor. The Insurance Specialist is also responsible for ensuring that all collection activities have been taken and documented.

Job Responsibilities:

Employee will adhere to all Policies and Procedures at all times Research and correct all account errors immediately Review entire account and apply corrections/updates to all services as appropriate Perform all required collection activity, ensuring an effective initial encounter with the charges and actions to get paid whenever possible.

Activities will include:

Take all actions required to resolve account discrepancies Work assigned A/R class reports and denial queues; No Response; resolve accompanying issues and document the patient's account, in the prescribed format, for all actions taken Be familiar with payors' medical policies, utilize websites when working denials and provide all supporting information, correcting the diagnosis when appropriate Utilize payor tools such as "Clear Claims" review, "Humana Code Simulator", etc. to review payor edits and ensure and effective appeal Utilize Optum Encoder for NCCI pairs, diagnosis/procedure descriptions, global dates, etc. Complete all Customer Service Account Review requests within the 5 day timeframe. Return urgent calls on same business day when possible Complete an electronic daily productivity sheet. These are to be accurate, computed as directed and detailed, covering all aspects of work completed each day Complete work on all custom reports within the required time frame. An example of these reports includes the no response reports, drug code review, and denial projects (e.g. state complaints) Monitor your payors' queue daily for trends, breakdowns in Payment Processing, etc. Respond to findings immediately, involving the Supervisor when needed Completing all steps required for rebilling/correcting claims (e.g. Availity-Refresh cloned claims process, MI corrected claims, etc.) Inform management of any pending problems or issues that have not been resolved. Escalate to next level of management if necessary Keep supervisor aware of any pending work or late responses to work sent to others for research Keep abreast of state and federal collection laws Keep abreast of filing and appeal deadlines for all payers Keep abreast of contractual payment guidelines Be aware of, and work toward, department goals as well as personal goals Maintain confidentiality of patient protected health information (PHI) as mandated by STRG procedures and HIPAA Privacy, Security, and HITECH regulations Utilize Outlook/Tickler to schedule follow-up as required (e.g. reissued checks, CSR issues with appeal in process, update requested by supervisor, etc.) Perform other duties as required

Supervisory Responsibilities:

None Experience /

Skill Requirements:

Basic understanding of arithmetic concepts; ability to communicate effectively, orally and in writing; negotiating skills; even temperament; minimum one year training/working in medical billing and collections; problem solving skills; typing speed of 45 wpm; basic knowledge of Microsoft products (e.g. Excel, Word, etc.); knowledge of CPT and ICD-10 Coding. Computer experience in Medical billing software program; Contract and fee schedule experience, HMO, PPO, direct work with appeals process and results; direct insurance company contacts and adjudication procedures knowledge; previous radiology experience; HCPCS Coding, knowledge of Correct Coding Initiative and Limited Diagnosis guidelines; prior experience navigating payer and clearinghouse websites.

Education:

High School Diploma or GED Attendance /

Work Schedule:

Maintaining and satisfying minimum attendance requirements is an essential function of this position, including working all full-time regular hours as established for this position and scheduled or emergency overtime. Full-time regular hours are defined as Monday through Friday, with after-hours or weekends as required. All employees in this job classification are required to satisfy this requirement. This job classification does not include "light duty" work or allow unpredictable or unrestricted absences.